Differential Diagnosis

My son has been treated by the Early Intervention in Psychosis team for nearly 3 years, with little success.  His case has not been straighforward and he has refused any kind of intervention, often giving monosyllabic answers but often quite articulate in defence of his own position.  This position is that he is strongly affected by what he calls "negative energy" from which he needs to protect himself via various rituals or even just escaping from "contamination."  He is withdrawn mostly, spending all his time alone in his room but not, as the CPN has recently observed "actively psychotic".  His current consultant (the fourth!) has said that he doesn't have psychosis and he doesn't have schizophrenia and she's referred him to the autism team.  I'm shocked, especially after all this time.

My son does seem to have delusional beliefs, he's withdrawn, he paces around and his self care is extremely poor.  This, to me , seemed to fit with the diagnosis of psychosis. At the same time though, I'm aware that there are other, longer standing features to this. He was referred to an audiologist as a very young child as he seemed to be hard of hearing, not responding to those around him.  He was, though, actually choosing to ignore people and remain in his own world.  He has always had what I call a "self contained" element to his personality.  And, although until recent years he has been quite sociable and able to join in very easily, he say's he's always actually felt like an outsider and that he didn't think he was ever really one of the group.

I'm finding it hard to piece things together.  He's an adult now (21) and he surely can't stay in his room forever.  What are the differences between psychosis and autism and how might a consultant differentiate.  I'm wondering what these labels mean and how they can be helpful to us in this situation.  So far I'm tired of hearing people saying that "He needs help" or "You need to get help" and the type of help not being specified.  I need to know what to do on a day to day basis to improve things. 

  

Parents
  • Former Member
    Former Member

    You can have ASD and be unaware of it and the people around you can be unaware. ASD on its own has very subtle signs and differences in behaviour. It is frequently an invisible disability. I was blissfully unaware of this for 56 years (but the signs were there if you knew what to look for). The strangeness of ASD leads to social difficulties, isolation, conflict, misunderstandings etc that ultimately can lead to mental disturbance. I guess that this might be close to going "Stir crazy". I suspect that this is where your son has got to. The symptoms are not those of ASD but they are symptoms of the mental disturbance that are the consequence of undiagnosed ASD. I ended up with depression, severe problems in thinking that people weere against me, and now have anxieties that get in the way of everyday life. I was behaving strangely, I was not functioning well in a lot of ways, it had got to me. Having a diagnosis can be a revelation and it can be the key that unlocks the door back to operating successfully in the real world.

    Therefore, you can't really look for a differential diagnosis between ASD and psychosis but the difference between psychosis and being stir crazy which, I guess, will look quite similar. The causes are different though. Someone who has been locked in a cell for 30 years can blame it on isolation, a true psychotic can lay the blame on chemical imbalances in the brain, a person with ASD will atrribute it to years of isolation and social conflict.

Reply
  • Former Member
    Former Member

    You can have ASD and be unaware of it and the people around you can be unaware. ASD on its own has very subtle signs and differences in behaviour. It is frequently an invisible disability. I was blissfully unaware of this for 56 years (but the signs were there if you knew what to look for). The strangeness of ASD leads to social difficulties, isolation, conflict, misunderstandings etc that ultimately can lead to mental disturbance. I guess that this might be close to going "Stir crazy". I suspect that this is where your son has got to. The symptoms are not those of ASD but they are symptoms of the mental disturbance that are the consequence of undiagnosed ASD. I ended up with depression, severe problems in thinking that people weere against me, and now have anxieties that get in the way of everyday life. I was behaving strangely, I was not functioning well in a lot of ways, it had got to me. Having a diagnosis can be a revelation and it can be the key that unlocks the door back to operating successfully in the real world.

    Therefore, you can't really look for a differential diagnosis between ASD and psychosis but the difference between psychosis and being stir crazy which, I guess, will look quite similar. The causes are different though. Someone who has been locked in a cell for 30 years can blame it on isolation, a true psychotic can lay the blame on chemical imbalances in the brain, a person with ASD will atrribute it to years of isolation and social conflict.

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