ASD Assessment + Childhood Chronic Pain = ??

I think most people diagnosed with ASD, who have had years of coping behind them, feel like imposters from time to time. It is partly because there are always people who are, or appear to be, worse affected than oneself. If there is no better explanation of how you are available than autism, then you are most probably autistic.

Thanks Martin - I'm inclined to agree. I've also dived so deeply into this topic since it came up as a potential thing that I'm at my most convinced state so far, after initially going through quite a range of imposter type thoughts it's making a lot of sense. Eitherway I'm coming to the conclusion that looking through an autistic lense will help me understand myself better

Thanks for this insight - upon looking again at the report, it does mention this Category of exclusion for the basis of being non-determined. I've had chronic pain since the age of 4 though. The only evidence i've been able to collect from before this age was being late with my milestones for speech. Didn't talk until i was 4-ish.

Hey Iain,

Thanks for this reply. Yes i did list pain as a potential sensory issue in my notes. I'm going to try bringing this up again.

This was a private assessment already so I've asked for a supplementory session to see if we can reach a clear diagnosis one way or the other before i look into a 2nd opinion.

I've re-read the report multiple times now - I think the angle they are pointing at is that some of my traits could be attributable to having pain, ie social issues could be down to being too sore to want to socialise, and there is no way to say they are a result of autism specifically.

To me the response is a positive of autism, because one assessor has said that you are autistic, and the other has not said that you are not autistic, so their assessment is null or indeterminate, rather than negative. Therefore, logically, you have an overall positive assessment.

I work with chronic pain populations and there is belief that chronic pain in itself can cause hypersensitivity, thus the trait of sensory issues could be caused by the chronic pain condition and not be an Autism trait. However, knowing which is which is anyone's guess and I am unsure how the psychiatrist could make that distinction. The evidence points the way as Iain states a lot of autistic people can manifest their hypersensitivity as chronic pain and again as stated one does not cancel out the other. Trying to figure out which caused the chronic pain is unnecessary and isn't helpful to anyone. 

Many diagnostic tools for other conditions state exclusions. The diagnostic criteria for Autism does not although the DSM5 states: 

D. The symptoms are not attributable to another medical or neurological condition

and the ICD 11 has one exclusion which is Rett syndrome.

If there is still push back if you can provide any evidence for sensory issues prior to the chronic pain starting, that may help. 

As someone else states if you can get a second opinion if possible. 

I would ask for a second opinion.

I've had chronic pain since my teens, talked about it during my assessment, and got a very straightforward autism diagnosis. If anything, the nature of my chronic pain conditions was another box ticked for my assessors, because they're conditions with known links to autism.

There are lots of issues causing chronic pain from childhood that are comorbid with autism, like irritable bowel syndrome and hypermobility. Because of that, I would be pretty concerned if an assessor was ruling out autism based on a person's experience of chronic pain- and then of course there's the fact that people can (and often do) have multiple unrelated things going on!

no-face said:

The 1st interviewer says I fit the criteria. The second interviewer says It's not possible to reach a diagnosis due to chronic pain since childhood

Anyone (autistic or NT) can suffer from chronic pain - it is not in itself an autistic trait so I would ask the second interviewer why they cannot reach a diagnosis. If there is enough trait evidence to establish an ASD diagnosis then having one extra issue does not cancel out all the rest. It is like saying you cannot be autistic because you have ADHD traits.

A common issue with autism is our hyper sensitivity to sensory input and this can manifest itself as pain (many people suffer from loud noises causing pain for example). In your case do you think it could be this? If so then it is just another supporting trait of autism.

If you can afford it then I would recommend a private assessment - they tend to have better qualified professionals on the whole.