"You're not autistic, you make facial expressions!"

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Is your psychologist aware that it is very unethical, unprofessional and in some jurisdictions, unlawful to practice beyond the scope of one's skill and knowledge and to refuse to make appropriate referrals where patient needs require skills and knowledge beyond their competency?

If you are in a position to do so, please consider making a complaint to relevant authorities.

That people with Aspergers Syndrome can and do make facial expressions is a matter of fact that anyone (including your psychologist) could confirm with a single reading of the (current addition) DSM criteria.

marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression,
The DSM list criteria does not describe marked absence (of facial expression), it describes marked impairment in use (of facial expression); evidently the above criteria is not necessary for diagnosis anyway.

The DSM does include a section of criteria that must each be met, and this section is utilized to posit 'exclusionary' criteria, or in other words, criteria that describe traits that are inconsistent with a diagnosis of Aspergers Syndrome and require that the trait be absent (for diagnostic criteria to be met). If no one with Aspergers Syndrome was able to make facial expressions, then the DSM could and (due to the utility of doing so) would require an absence of facial expression in this section of the criteria.

There is a very good reason your psychologist's (very denigrating) belief about Aspergers Syndrome is not incorporated into the DSM's diagnostic criteria, and that is quite simply that the belief is inaccurate nonsense.

In my view, the belief of these (apparently only too common) Tom Dick and Harriet bigots, that their absurd, inane, illogical and utterly denigrating stereotypes about us, are something that they have some right to base their clinical decision making on (in an area where they know themselves to not be clinically competent) is prejudicial, denigrating and very harmful to effected individuals. It is quite simply discrimination, and in my view, an abuse of our most basic human rights.

Might I suggest you obtain a printed copy of the expanded description of AS (in the DSM) that accompanies the list criteria, highlight the text that describes facial expressions as they sometimes occur in persons with AS and take this to your next session with this health "professional". Have this in your bag or pocket (where it cannot be seen) and ask your psychologist to repeat their view that you do not have AS because you exhibit facial expression. Hand them the printed description and ask them to read aloud the high-lighted section.

You might at this point wish to ask this psychologist if they are aware that practicing beyond the limitations of their competency is a very serious matter and perhaps also ask why you ought not make a complaint to relevant authorities given the significant discrepancy between the clinical advice you received and even the most basic of knowledge about AS.
Obviously anyone who believes people with AS cannot manifest facial expressions is not qualified to be giving any clinical advice about whether or not someone has the condition.

If you do intend to make a complaint (and if you are in a position to do so, I very much hope that you will make a complaint), it might be helpful if you are able to bring along a 'support person' who can act as a witness (to the psychologist's advice).

From what you describe, it appears this "psychologist" knows less about Aspergers Syndrome than just about any literate layperson armed with the DSM-IV TR could learn in 10 or so minutes.....or less. Whether or not you have AS, you deserve to receive health care services that comply with minimum standards of appropriate quality, and advice that you cannot have AS because you manifest facial expressions simply does not meet (or come even vaguely close to approaching) such standards.

I learnt to do several. Takes effort and gets me headaches, but yeah... it's possible.

Your dr also should know that we can learn to mimic facial expressions. My expressions are half the time, not accurate to how I am feeling or with the emotion I try to convey. This can take us a great deal of practice. More often than not I have a hard piercing expression.

you already have some excellent input here, but that's my two cents.

Pannd: Great post, I agree with everything you said. Aspergers is not a black and white disorder where you can say something like "you make face expressions/eye contact" or "you have friends therefore social skills" yet psychologists are very quick to make blanket statements. As a teen my mom was told I don't have Aspergers, I made eye contact. Rubbish.

Excellent point!! Yes you're exactly right, I tend to mimic facial expressions and mirror the person I'm talking to, giving the impression that I'm empathic and listening to them. Correct social facial expressions do not come naturally to me.

YOUR words prior, daniel, and more so those prior to quote,
however 'from' an expert, are at the very least very aptly appropriated,
and yours, still!
(apart from adapting to psychoes wordage, i do not doubt)

and more: they are very interesting indeed:
could you please elaborate: pray, tell more...


pretty [email protected]

Also, regarding eye-contact, I think I've shown that it is not as simple as the stereotype wants it to be. There is another aspect to this, being acused of staring. Being acused of staring is just about as common as disliking eye-contact. The key probably is if you like the person or not. The stereotype have developped because few Aspies have an intimate relation to their psych-doctor, and so will not want to have direct eye-contact with him/her.

Therapists can be a**holes. My therapist is horrible to me at times.

I've made facial expressions all my life, though I seem to make them more often when I'm in familiar surroundings &/or around people I'm incredibly comfortable with. Other than that, my expression is what I would call neutral, but others see it as sad, angry, or depressed. I've been stopped on the street before & asked "Why are you so sad?" when I was in a perfectly good mood.

agreed. that is the same for me.

I do many facial expressions, sometimes without realizing. Some of us may have trouble recognizing facial expressions but we can still do them ourselves.

I make facial expressions all the time. I usually don't have a flat affect. But sometimes I do when I am catatonic I just have a blank look on my face. Most of the time (even while depressed and even when I was suicidal at one point- not now don't worry) I have a big smile on my face, even while being dead.

pandd,

You'll find that people with Asperger's will display all of the symptoms to some extent or another, it's just that they most likely won't display them all in a clinical setting, and during the diagnostic interview, which is why there's a whole list that the clinician can choose from. When there's one, there'll be the others. For example, everyone with Asperger's will lack [appropriate] eye contact, whether it's not looking at people when you talk, looking through people, looking at a specific feature on the face, etcetera; even if it looks the part on the surface, it isn't when people dig deeper. If a clinician is focusing on appropriate facial expressions for the social and emotional context, it'll be hard for him to miss whether it's lacking or not.

People shouldn't interpret the DSM-IV-TR, that's what the clinicians do, and it even states such in the book. They go through classes that are DSM specific when they're at university (I've had some discussions with my psychiatrist on such).

This is kind of murky, even in terms of being quite sure what we mean by displaying a symptom.

Many of these traits will be displayed to some extent or another in many members of the non-autistic population, but the greater complication is that people with AS do not necessarily manifest a particular symptomatic trait at a clinical level at all times throughout their lives, even though they might actually manifest the trait at a clinical level at some other time in thier life (for instance a child with AS may not be impaired with regard to some particular trait when compared to their normally developing peers at age 5, but could be impaired in regards to the same trait at 8 years old).

I also wonder what you mean by display in particular. If display (in this context) means that a perfect observer would detect the symptom that may well be the case. If it refers to an ordinary observer, then it becomes a matter of the quality of the eye of the beholder.

Certainly if it is as you say, then it still remains the case that one need not manifest all symptoms clinically to receive diagnosis, and at any rate the symptom that is described in the DSM is impairment of facial expression not a complete lack of expression, so clearly the advice remains highly dubious.


Indeed. The point is that if it looks ok on the surface to someone who lacks the expertise to see beneath the surface, then that someone is not likely to detect or even accept that the symptom is present. This is why it is crucial that physicians not be making clinical judgments about the absence of AS unless they are appropriately skilled in recognizing the symptoms concerned.

If a clinician is focused on a patient not having AS they might not be focusing on finding impairment in appropriate facial expressions, and unless they have the skill to recognize and correctly attribute facial expression impairment to AS, it's not a productive exercise even if they are looking for it.

The fact is many physicians who utilize the DSM in the course of their duties, lack the skill to apply the criteria about AS to appropriate clinical standards. Many physicians have never knowingly encountered the condition and never knowingly had first hand opportunity to observe the symptoms.

Does it not also state in the book that inappropriate facial expressions are a possible manifestation of impairment in the use of facial expression? Obviously if inappropriate facial expression is symptomatic of AS for some individuals, it cannot be true that all persons with AS never make facial expressions (which is what this psychologist is described as having claimed).

Even if we accept that all symptoms are present and the physician can recognize them to some degree, as you yourself state not all symptoms will necessarily be detectable in any given clinical encounter, so the advice as described remains dubious before we even consider that the DSM does not state that people with AS cannot ever manifest facial expression.


Yes, they absolutely do go to lectures, do some readings, maybe hand in some assignments and probably sit some exams as well.

But none of this necessarily entails setting eyes on someone with AS, much less having had sufficient opportunity to observe a sufficient number of individuals for sufficient time such that one acquires the ability to reliably recognize symptoms as they manifest in widely varied persons who might have nothing else in common but their neuro-status.

Assessing for and diagnosing AS is a specialist field that most generalist clinicians do not specialize in.

I used to chat casually with one of my neighbors, now and then. Being an Aspie, I would always feel anxious that I was talking too much, or he might be annoyed at my chatter. One day, I was chatting away, and happened to mention that I had AS. Now, I have no idea why I did that, but things changed.

Whereas before, I felt that he at least liked the little chats, I have seen him about to leave his house, spot me, and then step back inside. Another time, I noticed that he was siting outside, and seemed to be having difficulty with his laptop. So, I asked what was wrong. He started to explain, and then muttered, "How did I get into this!" I felt that he was annoyed with me, and regretted being friendly. Now I feel like an idiot for messing everything up. I have had other people treat my like a ret*d, once they learned about the AS. Or else, as if I were some kind of genius, which is equally annoying. I wish I didn't talk so much!

Seems like it's the label that changes them and then they are annoyed because they don't see you as you anymore because their thoughts changed when you told them you have AS. That's one of the reasons why I don't tell anyone. I don't want things to change between me and someone.

That's very true for me too. I do make facial expressions, but as thewildeman said I think I tend to mimic more than show genuine emotion. I know intellectually when someone is complaining to show a sympathetic face and say things like "poor you" and if someone smiles at me I'll automatically smile back (even if I'm angry at that person and didn't mean to smile). I can become very blank and catatonic, and I've told my shrink that but obviously she hasn't seen it in the one hour every second week that she sees me And yeah I totally relate to the big smile on my face when I'm not feeling it. I've been stopped by strangers who ask what I'm so happy about...I wasn't even happy! I also get told I'm bubbly and always happy which I find amusing...bubbly and autistic don't really go together!

I make some really odd facial expressions... I have to constantly remind myself not to when I'm around other people. But holding them back is kinda uncomfortable. I suppose I probably make the usual facial expressions as well, but I don't know for certain.