Expert: Trey McGowan - 11/18/2007

Question
My husband has been in a downward spiral after losing his job several years ago.  He has been on/off antidepressants for several years and is now off them.  He is a very intelligent person, but has extreme difficulties with communicating and expressing his emotions.  He is also unable to make decisions about his life, and has chosen to isolate himself from family and friends. He has struggled with these issues since childhood.  Is it possible he is autistic in some way and where should I ask for help to have him diagnosed? He has met psychiatrists and psychologists and this has never been mentioned - only that he seems to suffer from an adjustment disorder (he is Swedish living in the US) and PTSD. I am open to any suggestions that might help him, I am at my wits end as nothing (therapy, drugs etc) seems to help him, he is just getting worse.

Answer
Hello there, Regina!

Here comes the 'I am not a doctor' announcement again: I am not a doctor, so please don't take my word here as gospel. However, the biggest issue is that while yes, *many* people have gone through life autistic and not been diagnosed, the older they get, the harder it can be to tell these things. A lot of the time, they have learned their own 'coping mechanisms' to deal with the typical autistic symptoms, having learned that they are not 'appropriate behaviour'. Thus, many high-functioning autistics and Asperger's Syndrome adults may never be diagnosed.

In the case of your husband, simply saying 'He has difficulties communicating' makes it difficult to be able to guess whether this is autism or not.

Here are a few articles that have diagnostic aids:
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Asperger_syndrome...
This is, obviously, more for Asperger's Syndrome than ciassic autism, but the two often express themselves similarly in a high-functioning situation.

http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=1045&a=3341
An article about bringing it up with your doctor as well as diagnostic tools. Again: this is more for Asperger's.

http://www.autismsocietycanada.ca/life_with_asd_adults_youths/resources/index_e....
Resources and links that might help diagnose, as well as give some support in the issue.

Being as I'm not completely sure where you are in the US, I have to just say that the best thing you can do is to use the information in the second link about talking to your doctor, and see if maybe there is an individual in or around your area who can work with the diagnosis of Developmental Disorders in adults. It is never too late to get some intervention. And sometimes, even realizing that he is not alone, and finding effective coping and communication methods, may well help some of the issues while drugs and therapy can work on the rest.

Now, we get into the other difficulties: the obvious depression issues that your husband is going through. The fact is that, while if he has ASD, it would be contributing to the depression, it is not causing it. This could be what is called a 'comorbid' disorder. In other words, it is existing alongside another disorder, and becoming either worsened or muddled with it. If you go looking for assistance for him, I suggest that you see if you can find an individual who is experienced in dealing with 'Dual Diagnosis'. This is the terminology for those who deal with Developmental Disorders as well as Mental Health Issues.

However, I do have to admit that the biggest issue right now, while he may well have some autism-like traits, is indeed the depression and isolation. Trying to figure out why things aren't working might be the first step in getting some of them fixed. Is it because he doesn't trust the doctor? Try and find one he does trust. One who has worked with people who have communications issues would be a good start. Is it because of those communications difficulties? See if you can find a way around them. Maybe he types or writes better than he speaks. Maybe he can use hand signs. I'm not certain the level of communication issues he has, so please excuse if it sounds like I'm talking out my butt.

Above all else, try and find something that is comfortable for him to give him to hold on to. Maybe make a simple schedule, where you do the same thing at the same time. You don't need to schedule the *whole* day away, but try drawing some firm schedules and patterns. See if that helps give him something to hold on to. Especially let him make the schedules if at all possible. If he is, indeed, ASD, that alone may well give him a little comfort in a life that's probably horribly disturbing for him.

And see if you can get back on antidepressants. Particularly if the downward spiral has gotten worse without them.

Hopefully some of these suggestions helped, and if there's questions, detail, feedback, or whatever, don't hesitate to add on. Luck and best wishes to you both in these trying times.

Trey