Diagnosis in a 50 year old male.

I have read this about the DSM-5 a thousand times, and I'm fed up of reading about 'impairments' and 'restricted' patterns of behaviour. Who wrote the DSM-5? Are they autistic? Presumably, the psychologist who conducted my autism assessment had read the DSM-5. She suggested in my report that I ought to have asked more questions about her. Excuse me? My assessment appointment was a hugely significant appointment for ME. It would have been inappropriate to ask questions about her. And yet, I'm 'impaired'. I have autistic friends and neurotypical friends. It's easier to communicate with the autistic ones. Does that mean neurotypical people are 'impaired' because it's harder for them to communicate with me? No, of course not.

(Reply to Paper. For some reason, the site won't let me post a direct reply to Paper. I don't know why).

You are quite correct. I'm American and in the DSM-5 (Diangostic and Staistical Manual, 5th edition) which is used by American psychologists to identify disorders, autism is literally defined as a spectrum disorder that is characterized by "persistent deficits in social communication and social interaction across multiple contexts."

The DSM-5 outlines specific criteria that must be met for a diagnosis of ASD, which includes both qualitative impairments in social functioning and the presence of restricted, repetitive patterns of behavior.

Interesting. I disagree with you, but I'm interested in your take on things.

It's not framing, it's fact. Deficit is the accurate medical term based on the dictionary definition and what it is describing. It's not just about being bad at small talk, in fact that wasn't even mentioned.

Some people take offence or consider it insulting to describe it as deficits, but that is what it is - a lack in ability to do something. It makes it more difficult, even if you develop coping mechanisms or mask, the difficulty is still there.

In autism, social interaction and communication is impaired, it's one of the defining characteristics of it. You could also say they are "difficulties" or maybe "differences", but the latter implies it's not an issue, when it actually negatively affects an autistic person's ability to socialise and form relationships throughout their life.

I despise the framing of autistic communication differences as deficits. I could just as easily frame small talk and an insistence on eye contact as deficits. 

I received a clinical diagnosis of autism when I was 60. This was four years ago. I was a teacher at the time. To reduce my anxiety, I:

* transferred from a school with 3,500 students in a metropolitan area to a rural school with just 350 students

* stopped dating because dating made me feel awkward and also cost a lot of money. 

* used the move to end the few friendships I had. While different people with ASD have different strengths and weaknesses, my social awkwardness is such that even being with people whom I actually like is always inherently stressful. By giving myself permission to embrace my inner recluse, I reduced my stress by having more personal me time.

* told my school administrators that I was autistic. They gave me some reasonable work related accommodations such as excusing me from attending school assemblies. While there was an unofficial expectation that teachers attend local sporting events, no such expectations applied to me. 

* long before I was diagnosed with autism, I was diagnosed with post traumatic stress disorder and chronic depression. My therapist recommended that I get one or more pets. I wound up adopting some kittens. I think this was one of the best decisions I ever made because having cats taught me about the importance of caring for others. Since cats can be hypersensitive about their owner's feelings, the care I gave my cats was responded tenfold with lots of cuddles, purring, and comfort - especially on days when my depression was particularly acute. Although my initial two cats have long since crossed the rainbow bridge, I now share my home with four feline companions. 

* built personal me time into my daily schedule so that I could have time to rest, to relax, and to emotionally recharge. I did this in part by always making sure that I had time to engage in one or more of my special interests. When I focused upon a special interest, I felt a lot of my stress fall away. 

* made sure that I got plenty of sleep. 

Well it is one of the main diagnostic criteria:

Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Most autistic people do struggle with socialising. They may actually want to be social, but struggle to translate it into practice. But it is a spectrum, so some people may suffer from this less or become very good at masking it.

I don't understand why autistic poeple cannit be sociable. Yes we struggle with inane smalltalk and knowing when to but into a conversation but that does nit stop us talking to poeple. Also, this of us who have only realised we are autistic in later life have had a lifetime to develop coping mechanisms and ways of trying to conform. It really reflects badly on the assessor if they do not understand this.

I too am waining for my official diagnosis but the fact that being autistic explains so much leaves me with no doubt that I am. 

No worries - the NAS advises against using 'severe' or 'mild' in the context of autism, but I'm mindful of being the word police. That said, perhaps 'obsessive on routines' could be rephrased as 'a strong need to follow patterns of behaviour that provide me with comfort and satisfaction, especially as they result in things being done correctly'? 

That's interesting.  Have you felt post diagnosis that there have been any useful pieces of information you've picked up on?

Have you read anything about Autism yet?

I can recommend this book by Tony Atwood https://www.autismforthvalley.co.uk/files/5314/4595/7798/Attwood-Tony-The-Complete-Guide-to-Aspergers-Syndrome.pdf

It's a useful combination of current science, historical accounts and quotes from people with Autism.  The latter part I found the most enlightening, I read it with a notepad and jotted down certain things as were interesting.  One of which was something along the lines of

"...it took me years to realise normal people could experience more than one emotion at once, for years I refused to believe it was possible.  But now I understand it's a part of many peoples lives they never question"

It sounded like it was important, but crucially I didn't understand what the person meant.

About a week later the penny dropped when I was speaking to her, and she was talking about her father in hospital.  She was talking about what an absolute piece of XXXX he was, that he was violent, mean spirited, a real XXXX job.  But then ended it by saying "...but I still love him though, he's my Dad".

For me, no.  That man sounds like a complete XXXX, he can die in hospital, wouldn't bother me.  But that's me!!!!!! I can only have one emotion at once!!! It dawned on me why that was so important now, it described something I'd heard before "what can you do they're family" sentiment. I've never got that before, but now it made sense in a Autistic kind of way.

So anyway, is there anything you've learnt so far about yourself? 

It came about after some individual counselling sessions which i was trying to do some work on why i cant express how i feel and the challenge that places on a marriage. My wife has been an advocate for therapy over the years and i decided to give it a go but something wasn’t dropping.  I very much struggle with understanding and empathising with emotions,  since covid it has definitely become worse in becoming more insular and routine driven with all my work moving online as opposed to face to face.  I noticed i hated the camera being on in zoom sessions and also on family FaceTime so started to turn it off on all sessions.  I feel more anxious and in a constant state of alert as opposed to depressed and do feel slightly better sine the assessments highlighted some traits. 

Hey there JMC,

I'm sorry I'm not going to answer your question  but I am going to bounce one straight back at you - what was it that led to your relatively late diagnosis.

Having only got diagnosed this year myself at the age of 46 I'm interested in peoples journey.

The reason for which is because my own lack of understanding of why I am, why we are - and how we do it, is just so undefined, hearing about others lives in details helps me, just by hearing struggle, plan, solution.

I'm happy going first, I used to be defined by depression.  I've had so much therapy and medication, even going into our local "mental health medical unit" on a number of occasions trying to work out why I hated living so much.  One throw away comment from a nurse put me on the path to formal diagnosis - since then, I happily identify as Autistic.

(In my work in education, I have met many parents who are fearful of labelling their child as "autistic" as if it's on the same scale as "sex offender"!! But for me, never before has the cliché of knowledge being power been more true)

So what's your story up until today?

Maybe wrongly worded but obsessive on routines. Poor understanding of peoples emotional needs as i cant quite seem to understand their feelings. Etc etc. 

Congratulations on your diagnosis. I was diagnosed last year, aged 41. I make YouTube videos as a way of articulating and dealing with my many anxieties. 

What is a 'severe' trait of autism?