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Differential Diagnosis

Jenny Butterfly

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  He is withdrawn mostly, spending all his time alone in his room but not, as the CPN has recently observed "actively psychotic".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My son does seem to have delusional beliefs, he's withdrawn, he paces around and his self care is extremely poor.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

  • The problem, if it is autism, is you get hurt too often by encounters with the world outside. You don't have good social referencing and cannot identify 'norms' or get feedback on given situations by others. There is a tendancy to dwell on perceived hurts and obstacles which can negatively re-inforce the bad experiences. So you end up in the safest place - one room, with familiar clutter.

    Given he has been treated for everything other than autism, he has probably had even less chance than most to work out what might be happening. And there is a point after which other people telling you what to think, what is wrong with you, or that you need help, the barriers go up permanently.

    The problem is, the options he has at the moment, talk to yet another psychologist.

    If it is autism, the rituals may be for security - similar to stimming. The negative energy may be what the rituals protect him from. The rituals are a means of keeping in control in a world outside that seems alien.

    Something in this made me pick "Freaks, Geeks & Asperger Syndrome - a user guide to adolesence" by Luke Jackson (Jessica Kingsley Publishers 2002 ISBN 978 1 84310 098 0 - this code helps a librarian or bookseller find it). OK your son is 21 now, but the book is relevant to his recent life history perspectives. Luke Jackson's book is a bit precocious - at the time of writing 13 - so readers may wonder if he really wrote it. The content is light hearted and playful. There is a chapter on fascinations and fixations that covers a lot of things psychiatrists might approach as psychosis rather than autism. He describes for example ritual sequences he had to do before going to bed. In a life that lacks connectivity and where the outside world can be hostile, these compulsive rituals are making safe.

    An amazing number of respondents on here have teenage and early adult sons or daughters who stay in their room, often linked up to their computer, for many hours, and they worry it is harmful. When you find the world difficult to handle, this is one safe place, and activities there are reassuring. What they are missing, from a non-autistic spectrum, may be contexts they are only too happy to avoid.

    Poor self care is a fairly common symptom and relates to both executive function and sensory issues. Hair cutting, combing, washing and teeth cleaning may actually be very uncomfortable, even painful if hypersensitive. Clothing may be uncomfortable therefore some clothing favoured even when on too long. On the executive function side, remembering to think about keeping up appearances may be difficult, needing prompts, and there isn't the social pressure to be nice to be around.

    Most people on the autistic spectrum feel like an outsider - that's why it is called "wrong planet syndrome". Not being able to use eye contact, facial expression, body language properly, and not able to read it in others means very little social referencing - no feedback from other people - lifelong - it never happens (much). You aren't on the same wavelength as other people.

    I've suggested Luke Jackson's book because it might fit. There are others, but the things you are describing suggest to me his is closest. While it is early teen in its target audience, it covers the right ground. Another childhood perspective is "Martian in the Playground" by Clare Sainsbury, and there is Marc Fleisher's Making Sense of the Unfeasible - being an autobiography from childhood to early adulthood.

    Would he read a book if presented to him?

Reply

  • The problem, if it is autism, is you get hurt too often by encounters with the world outside. You don't have good social referencing and cannot identify 'norms' or get feedback on given situations by others. There is a tendancy to dwell on perceived hurts and obstacles which can negatively re-inforce the bad experiences. So you end up in the safest place - one room, with familiar clutter.

    Given he has been treated for everything other than autism, he has probably had even less chance than most to work out what might be happening. And there is a point after which other people telling you what to think, what is wrong with you, or that you need help, the barriers go up permanently.

    The problem is, the options he has at the moment, talk to yet another psychologist.

    If it is autism, the rituals may be for security - similar to stimming. The negative energy may be what the rituals protect him from. The rituals are a means of keeping in control in a world outside that seems alien.

    Something in this made me pick "Freaks, Geeks & Asperger Syndrome - a user guide to adolesence" by Luke Jackson (Jessica Kingsley Publishers 2002 ISBN 978 1 84310 098 0 - this code helps a librarian or bookseller find it). OK your son is 21 now, but the book is relevant to his recent life history perspectives. Luke Jackson's book is a bit precocious - at the time of writing 13 - so readers may wonder if he really wrote it. The content is light hearted and playful. There is a chapter on fascinations and fixations that covers a lot of things psychiatrists might approach as psychosis rather than autism. He describes for example ritual sequences he had to do before going to bed. In a life that lacks connectivity and where the outside world can be hostile, these compulsive rituals are making safe.

    An amazing number of respondents on here have teenage and early adult sons or daughters who stay in their room, often linked up to their computer, for many hours, and they worry it is harmful. When you find the world difficult to handle, this is one safe place, and activities there are reassuring. What they are missing, from a non-autistic spectrum, may be contexts they are only too happy to avoid.

    Poor self care is a fairly common symptom and relates to both executive function and sensory issues. Hair cutting, combing, washing and teeth cleaning may actually be very uncomfortable, even painful if hypersensitive. Clothing may be uncomfortable therefore some clothing favoured even when on too long. On the executive function side, remembering to think about keeping up appearances may be difficult, needing prompts, and there isn't the social pressure to be nice to be around.

    Most people on the autistic spectrum feel like an outsider - that's why it is called "wrong planet syndrome". Not being able to use eye contact, facial expression, body language properly, and not able to read it in others means very little social referencing - no feedback from other people - lifelong - it never happens (much). You aren't on the same wavelength as other people.

    I've suggested Luke Jackson's book because it might fit. There are others, but the things you are describing suggest to me his is closest. While it is early teen in its target audience, it covers the right ground. Another childhood perspective is "Martian in the Playground" by Clare Sainsbury, and there is Marc Fleisher's Making Sense of the Unfeasible - being an autobiography from childhood to early adulthood.

    Would he read a book if presented to him?

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